Medical Claims Support I

About the Role

The Medical Claims Support I position at Moda Health plays a critical role in ensuring the smooth processing and adjustment of medical claims across various lines of business. This role is vital for maintaining the integrity of the claims process, particularly for Medicare and Medicaid plans, which often require meticulous attention to detail. In the initial months, you will engage in training on the specific systems used for claims processing, as well as familiarize yourself with Moda Health’s policies and procedures. By collaborating with team members, you’ll quickly develop a strong foundation in medical claims management while contributing to the organization’s mission of delivering quality healthcare.

Key Responsibilities

• Investigate and process adjustments for medical claims across all business lines, ensuring accuracy and compliance with regulations.
• Handle the coordination of benefits (COB) claim adjustments specifically for Medicare and Medicaid plans, which involves comprehensive file reviews and updates.
• Manage overpayment recovery processes and underpayment adjustments, taking necessary corrective actions in a timely manner.
• Issue adjustment-related correspondence to both members and providers, ensuring clear communication of changes and updates.
• Respond to customer service inquiries related to claims, demonstrating excellent communication skills and a customer-focused approach.
• Perform payment offsets and validate stop payment requests, maintaining thorough documentation of all actions taken.

Requirements & Qualifications

• A high school diploma or equivalent is required for this role, providing a foundational level of education.
• At least six months of experience in medical claims processing or customer service is necessary, with a proven track record of exceeding performance expectations.
• Prior experience as a Processor I is highly desirable, with at least 12 months of consistent high-level performance.
• Strong written and verbal communication skills are essential, allowing for effective interaction both internally and with external partners.
• Proficiency in 10-key data entry at a speed of 135 wpm is required, alongside a typing speed of at least 35 wpm on a computer keyboard.

What You’ll Gain

• Experience in the healthcare sector, enhancing your understanding of medical claims and insurance processes.
• Development of strong organizational skills as you manage multiple tasks and meet deadlines in a fast-paced environment.
• Opportunities for career advancement within Moda Health, as you build expertise that can lead to more specialized roles.
• The chance to work in a diverse and inclusive environment that values different perspectives and experiences, contributing to your personal and professional growth.

How to Apply

If you are interested in this opportunity, please submit your application through the company page by following this link: Apply here.